Mini-CEX應用於畢業後一般醫學訓練第一年住院醫師之內科教學－成大經驗

Implementation of the Mini-CEX during the Teaching of Internal Medicine to Postgraduate Year One Residents: Clinical Experience at the National Cheng Kung University

10.6145/jme.200912_13(4).0005

陳柏齡(Po-Lin Chen)；鄭修琦(Hsiu-Chi Cheng)；謝棟漢(Tung-Han Hsieh)；林威宏(Wei-Hung Lin)；劉嚴文(Yen-Wen Liu)；蔡良敏(Liang-Miin Tsai)

迷你臨床演練評量 ； 畢業後第一年住院醫師訓練 ； mini-clinical exercise examination ； postgraduate year 1 ； PGY1

Journal of Medical Education

13卷4期（2009 / 12 / 01）

249 - 257

繁體中文

前言：迷你臨床演練評量(mini-CEX)自引進台灣後，因有效而廣泛使用於臨床教學評估。成大醫院內科部首度在2007年2月於一般內科病房採用mini-CEX作為教學評估工具，因此本研究評估mini-CEX在成大一般內科實行19個月的情形，範圍包括mini-CEX的適用性和在臨床教學的應用。材料與方法：參與的臨床教師包括7位內科老師，在使用此項評估工具之前皆有國內mini-CEX相關工作坊的受訓經驗，受評學員為輪訓至一般內科病房的畢業後第一年住院醫師(Postgraduate year 1, PGY1)。在mini-CEX實行19個月期間，共有44位學員接受過共計65次的評估。結果：每次評估所需時間約為18分鐘，大部份(84%)的臨床問題屬於低難度和中難度，學生在mini-CEX中七項領域的得分，集中於6分至7分。分析學生遇到的臨床狀況，疾病診斷占71.6%，病史詢問68.3%，治療和病人衛教較少，分別為43.3%和50%。老師的回饋顯示，衛教和人道專業項目是較少被回饋的項目。我們也針對其中完成PGY1內科訓練的24位學員進行問卷調查，結果顯示學員普遍認為mini-CEX可以幫助臨床學習和發現缺失（92%和83%），75%的受訪者願意再次接受mini-CEX評估，並同意將來有機會將願意為使用mini-CEX作為評估工具(71%)。關於臨床老師的反應，mini-CEX被認為是一種實用且有效的評估工具，臨床醫師可以在很短的時間學習並熟悉此項評估工具，然而，我們的老師認為評估項目中，人道專業屬於比較困難評量的領域。結論：從成大內科實施的經驗觀察，mini-CEX是一種對於學生和老師都很實用的內科教學工具。但是，為了維持mini-CEX評估結果的品質，需要鼓勵更多的臨床醫師和學生熟悉並參與mini-CEX，而經由mini-CEX評估產生的結果可以作為臨床教學改進的參考。

Introduction: The mini-CEX (Mini-clinical exercise examination) has been introduced into Taiwan and has become popular as an effective assessment tool. At the National Cheng Kung University Hospital, the mini-CEX evaluation system has been in use since February 2007 on the general medicine ward. After 19 months of implementation, this study was undertaken to evaluate the fitness of the tool and its application in terms of improving clinical teaching. Materials and Methods: The evaluators included seven visiting internal medicine staff who had attended workshops associated with mini-CEX evaluation. The trainees were the first year residents who had rotated through the general medicine ward, where there is a general medicine training unit. A total of 44 trainees and 65 encounters were evaluated during the 19-month study period. Results: The time taken for each evaluation was about 20 minutes. Most (84%) of the patient problems were of low to intermediate complexity. The scores obtained by the students were even across the seven aspects of mini-CEX. Most of the encounters involved diagnosis of a disease (71.6%), and history taking (68.3%), but fewer involved therapy (43.3%) and education of a patient (50%). Our results indicated that tutors rarely gave feedback to the trainees in areas associated with counseling skills and humanism/professionalism, which matches the variation in types of encounter experienced to some extent. In addition, we investigated 24 residents who had completed their PGY1 training in internal medicine and had experienced the mini-CEX evaluation system; this was done by questionnaire. The results demonstrated that the majority of these residents considered the mini-CEX to be beneficial to clinical practice (92%), but these residents also pointed out a number of disadvantages for students (83%). Most of them also indicated that they were willing to be evaluated repeatedly (75%) and were happy to become a rater of the mini-CEX (71%). With regard to assessment by tutors, the mini-CEX was alsoconsidered by them to be a practical and effective assessment tool. Physicians were able to learn quickly how to use it and became experienced in applying it in a short time. However, tutors indicated that they found it difficult to rate students in area of humanism and professionalism. Conclusion: In our experience, the mini-CEX promises to be one of the most practical and useful evaluation systems for both trainees and tutors who are involved in internal medicine. Moreover, multiple assessments by multiple observers are important in order to maintain the quality of the mini-CEX. Therefore, it is important to encourage physicians to become involved in the system. Moreover, the quantitative and qualitative data produced by mini-CEX should become a reference point for improving clinical teaching.

1. Chen W,Lin CC,Huang CC(2006).Implementation of the mini-CEX(Clinical Evaluation Exercise): experiences and preliminary results.J Med Educ,10,232-239.
   連結：
2. Chen W,Lin CC,Huang CC(2006).Implementation of the mini-CEX(Clinical Evaluation Exercise): experiences and preliminary results.J Med Educ,10,232-239.
   連結：
3. Chen W,Tsai CH,Huang KY(2005).Clinical medical education and mini-CEX(Clinical Evaluation Exercise).J Med Educ,9,370-377.
   連結：
4. Lai MM,Chen W,Chen HS(2008).Stakeholders' feedback and satisfaction with the use of the mini-CEX to assess medical students.J Med Educ,12,160-166.
   連結：
5. Yeh JH,Chiu HC,Chou TY(2008).Implementation of the mini-CEX during the clerkship part of medical training.J Med Educ,12,77-83.
   連結：
6. Yeh JH,Chiu HC,Tsou KI(2007).Validity of the mini clinical evaluation exercise- experience at the Fu-Jen Catholic University.J Med Educ,11,39-46.
   連結：
7. Alves de Lima A,Barrero C,Baratta S(2007).Validity, reliability, feasibility and satisfaction of the mini-clinical evaluation exercise (mini-CEX) for cardiology residency training.Med Teach,29,785-790.
8. Durning SJ,Cation LJ,Markert RJ(2002).Assessing the reliability and validity of the mini-clinical evaluation exercise for internal medicine residency training.Acad Med,77,900-904.
9. Hatala R,Ainslie M,Kassen BO(2006).Assessing the mini-clinical evaluation exercise in comparison to a national specialty examination.Med Educ,40,950-956.
10. Hauer KE(2000).Enhancing feedback to students using the mini-CEX (Clinical Evaluation Exercise).Acad Med,75,524.
11. Holmboe ES,Huot S,Chung J(2003).Construct validity of the miniclinical evaluation exercise (miniCEX).Acad Med,78,826-830.
12. Norcini JJ,Blank LL,Arnold GK(1995).The mini-CEX (clinical evaluation exercise): a preliminary investigation.Ann Intern Med,123,795-799.
13. Norcini JJ,Blank LL,Duffy FD(2003).The mini-CEX: a method for assessing clinical skills.Ann Intern Med,138,476-481.

1. 潘筱芳(2021)。原發性高醛固酮症之診斷與治療。臨床醫學月刊，88(4)，637-641。
2. (2024)。以迷你臨床演練評量評估物理治療實習學生之學習成效。醫學與健康期刊，13(1)，25-36。